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Published online: 2019-12-09
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Optimal timing of contrast-enhanced three-dimensional magnetic resonance left atrial angiography before pulmonary vein ablation

Susanne Löbe, Claudia Leuthäusser, Alexander Pölkow, Sebastian Hilbert, Philipp Sommer, Andreas Bollmann, Gerhard Hindricks, Ingo Paetsch, Cosima Jahnke
DOI: 10.5603/CJ.a2019.0112
·
Pubmed: 31909472

open access

Ahead of print
Original articles
Published online: 2019-12-09

Abstract

Background: To achieve high image quality of cardiovascular magnetic resonance (CMR) pulmonary vein (PV) angiography prior catheter ablation in patients with atrial fibrillation, optimal timing of the angiographic sequence during contrast agent passage is important. The present study identified influential cardiovascular parameters for prediction of contrast agent travel time.

Methods: 106 consecutive patients underwent a CMR examination including 3-dimensional contrast-enhanced PV angiography with real-time bolus tracking prior to catheter ablation. Correct scan timing was characterized by relative signal enhancement measurements in the pulmonary artery, left atrium (LA), and ascending aorta. Furthermore, left- and right-ventricular function, left- and right-atrial dimensions, presence of mitral or tricuspid insufficiencies, and main pulmonary artery diameter were determined.

Results: The highest relative signal enhancement in LA demonstrated optimal scan timing. Contrast agent travel time showed wide variability (range: 12–42 s; mean: 18 ± 4 s). On univariate analysis, most cardiovascular parameters correlated with contrast agent travel time while on multivariate analysis left- and right-ventricular function remained the only independent predictors, but overall a poor fit to the data (adjusted R2, 27.5%) was found.

Conclusions: Contrast agent travel time was mainly influenced by left- and right-ventricular function but prediction models poorly fitted the data. Thus, 3-dimensional PV angiography prior to PV ablation procedures necessitates real-time assessment, with visual determination of individual contrast agent passage time to ensure consistently high CMR image quality.

Abstract

Background: To achieve high image quality of cardiovascular magnetic resonance (CMR) pulmonary vein (PV) angiography prior catheter ablation in patients with atrial fibrillation, optimal timing of the angiographic sequence during contrast agent passage is important. The present study identified influential cardiovascular parameters for prediction of contrast agent travel time.

Methods: 106 consecutive patients underwent a CMR examination including 3-dimensional contrast-enhanced PV angiography with real-time bolus tracking prior to catheter ablation. Correct scan timing was characterized by relative signal enhancement measurements in the pulmonary artery, left atrium (LA), and ascending aorta. Furthermore, left- and right-ventricular function, left- and right-atrial dimensions, presence of mitral or tricuspid insufficiencies, and main pulmonary artery diameter were determined.

Results: The highest relative signal enhancement in LA demonstrated optimal scan timing. Contrast agent travel time showed wide variability (range: 12–42 s; mean: 18 ± 4 s). On univariate analysis, most cardiovascular parameters correlated with contrast agent travel time while on multivariate analysis left- and right-ventricular function remained the only independent predictors, but overall a poor fit to the data (adjusted R2, 27.5%) was found.

Conclusions: Contrast agent travel time was mainly influenced by left- and right-ventricular function but prediction models poorly fitted the data. Thus, 3-dimensional PV angiography prior to PV ablation procedures necessitates real-time assessment, with visual determination of individual contrast agent passage time to ensure consistently high CMR image quality.

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Keywords

cardiovascular magnetic resonance imaging, angiography, pulmonary vein, atrial fibrillation, catheter ablation

About this article
Title

Optimal timing of contrast-enhanced three-dimensional magnetic resonance left atrial angiography before pulmonary vein ablation

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2019-12-09

DOI

10.5603/CJ.a2019.0112

Pubmed

31909472

Keywords

cardiovascular magnetic resonance imaging
angiography
pulmonary vein
atrial fibrillation
catheter ablation

Authors

Susanne Löbe
Claudia Leuthäusser
Alexander Pölkow
Sebastian Hilbert
Philipp Sommer
Andreas Bollmann
Gerhard Hindricks
Ingo Paetsch
Cosima Jahnke

References (17)
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